Presentation delivered by Speakers Tiffany Ferguson, LMSW, ACM, System Director of Health and Care Management, Northern Arizona Healthcare and PathfinderHealth ACO & Robert Thames, FACHE, FHFMA, Former President and Chief Executive Officer, Northern Arizona Healthcare at the marcus evans National Healthcare CXO Summit Spring 2018 held in Orlando FL

1. N O R T H E R N A R I Z O N A H E A L T H C A R E
1
Partnering with Community Providers to
Achieve Top-Decile Readmission Rates
Tiffany Ferguson, LMSW, ACM, System Director of Health and Care Management
Rob Thames, FACHE, FHFMA, Former President and CEO

2. N O R T H E R N A R I Z O N A H E A L T H C A R E
How to Keep People Out of the Hospital…
…without Going Broke
OR
The Joys of Population Health Success

3. N O R T H E R N A R I Z O N A H E A L T H C A R E
Outline
1. Why?
2. What?
3. How?
4. So What?
Context

4. N O R T H E R N A R I Z O N A H E A L T H C A R E
1. Why?
“The #1 quality
issue in U.S.
healthcare is
cost.”

5. N O R T H E R N A R I Z O N A H E A L T H C A R E
2-3 times % GDP:
Not globally
competitive for
U.S. Companies

6. N O R T H E R N A R I Z O N A H E A L T H C A R E
New York Times, Jan. 2, 2018
(recent study in JAMA by scholars from the Institute for Health Metrics and Evaluation in
Seattle and the U.C.L.A. David Geffen School of Medicine)
(Let’s not forget…)

7. N O R T H E R N A R I Z O N A H E A L T H C A R E
TCC = p x q
Population
Health
H x T

8. N O R T H E R N A R I Z O N A H E A L T H C A R E
Outline
1. Why?
2. What?
3. How?
4. So What?
OR

9. N O R T H E R N A R I Z O N A H E A L T H C A R E

10. N O R T H E R N A R I Z O N A H E A L T H C A R E
$

11. N O R T H E R N A R I Z O N A H E A L T H C A R E
WTF

12. N O R T H E R N A R I Z O N A H E A L T H C A R E
Outline
1. Why?
2. What?
3. How?
4. So What?

13. N O R T H E R N A R I Z O N A H E A L T H C A R E
The Issue: Avoiding a Reactionary Process
Birth
Process of Illness
ACUTE EPISODE
CHRONIC ILLNESS
Purpose

14. N O R T H E R N A R I Z O N A H E A L T H C A R E
The Goal: Population Health Perspective
Birth
Process of Illness
CHRONIC ILLNESS
ACUTE EPISODE
CARE
MANAGEMENT

15. N O R T H E R N A R I Z O N A H E A L T H C A R E
Objectives for Achievement
• Understand your gaps and fill in the holes
• Integrate community care management with physician practices
• Care Management through the continuum
• Optimizing our Value based metrics & documentation efforts
• Outcomes based practices
• Deploy Remote Patient Monitoring
• Chronic condition management across Northern Arizona for CHF, COPD,
Diabetes, Pneumonia, PT/INR management.

16. N O R T H E R N A R I Z O N A H E A L T H C A R E

17. N O R T H E R N A R I Z O N A H E A L T H C A R E

18. N O R T H E R N A R I Z O N A H E A L T H C A R E
Community
• Know your communities and stakeholders
• Establish practical post-acute partnerships that focuses on key objectives and
results
• Address social determinants of health
• Partnership with Social Service agencies for community specific efforts to impact results and
improve health.
• Maintain economic stability
• Avoid direct cost, partner (CIP, Housing, BH Authorities), enhance payor based incentive
populations through the your ACO for gain sharing.

19. N O R T H E R N A R I Z O N A H E A L T H C A R E
Value Risk Arrangements
1. Type I: Existing, Quality Risk
• Medicare VBP
• Medicare- UHC VBP Contract
2. Type II: Existing, Full Risk
• Employees & Dependents with UMR/UHC
• Unfunded Population
3. Type III: New, utilization/Population Health Risk (through ACO)
• Medicare: MSSP Track 1+
• Medicaid- RHBA population health
• BCBS Commercial Contract
• Medicare- Humana Incentive program
• BCBS PCMH Contract
Cost: Utilization - $1.6M
Revenue: Coverage - $1.7M
1. MANAGE THE RISKS YOU HAVE
2. GET PAID FOR RISKS YOU ASSUME
3. GET PAID FOR PERFORMANCE YOU ACHIEVE!

20. N O R T H E R N A R I Z O N A H E A L T H C A R E
Outline
1. Why?
2. What?
3. How?
4. So What - What Else, What Next?

21. N O R T H E R N A R I Z O N A H E A L T H C A R E
Old World New World
Health Care=$$$ Social & Behavioral
Risk Pay to lose $ Get Paid to win Mission
Business
Model
Ops: Heads in Beds
Cmnty: Cash & B/S
‘Meds & Eds’
Leverage Cmnty
resources/investment
Next Frontier for Sustainable Health Improvement

22. N O R T H E R N A R I Z O N A H E A L T H C A R E
“When you discover you are riding a dead
horse, the best strategy is to dismount.”
- Lakota Tribal Wisdom
Healthcare
Business
Model

23. N O R T H E R N A R I Z O N A H E A L T H C A R E
10. Attempting to mount multiple dead horses in
hopes that one of them will spring to life.
11. Providing additional funding and/or training to
increase the dead horse’s performance.
12. Doing a productivity study to see if lighter
riders would improve the dead horse’s
performance.
13. Declaring that as the dead horse does not
have to be fed, it is less costly, carries lower
overhead, and therefore contributes substantially
more to the bottom line of the economy than do
some other horses.
14. Re-writing the expected performance
requirements for all horses.
15. Promoting the dead horse to a supervisory
position.
1. Buying a stronger whip.
2. Changing riders.
3. Threatening the horse with termination.
4. Appointing a committee to study the horse.
5. Visiting other sites to see how others ride dead
horses.
6. Lowering the standards so that dead horses can
be included.
7. Re-classifying the dead horse as “living,
impaired”.
8. Hiring outside contractors to ride the dead
horse.
9. Harnessing several dead horses together to
increase the speed.
Dead Horse Problem: Advanced Strategies Often Used

24. N O R T H E R N A R I Z O N A H E A L T H C A R E

25. N O R T H E R N A R I Z O N A H E A L T H C A R E
Mission:
Improving health, healing people.
Vision:
Always better care.
Every person, every time...together.